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In Rwanda, helping babies grow up HIV-free

A health worker collects blood samples from a couple in Kigali, Rwanda. UNICEF supports the health centre with medical supplies and training for health and laboratory personnel.

By Jenny Clover

NYAMATA, Rwanda, 2 April 2012 – In the small town of Nyamata, 45 minutes south of the nation’s capital, a comprehensive programme is giving the children of HIV-positive parents the best possible start in life.

At 3 per cent, HIV prevalence in Rwanda is relatively low, but prevalence rates are higher in urban areas and among women. The Government of Rwanda has embarked on a nationwide campaign to prevent the mother-to-child transmission (PMTCT) of the disease during pregnancy. Doing so requires working with both mothers and fathers to keep their children safe.

Helping couples help each other

“We are especially interested in discordant couples,” explained Dr. Placidie Mugwaneza, Head of HIV Prevention at the Rwanda Biomedical Centre. “This is a couple where one partner is HIV-positive and the other is not. Research shows that new infections among discordant couples are very high. We are targeting them to keep the negative partner negative and treating the positive partner to prevent HIV being passed on the baby during pregnancy or breastfeeding.”

Working with both members of the couple is essential to protecting the whole family’s health, Dr. Mugwaneza said. “If the mother is HIV-negative and the father is positive, it is important for the mother to remain negative so she does not pass it on to her child. And if the mother is HIV-positive while the father is not, it is very important for the mother to be supported by the father in receiving treatment for herself and the baby. We ask such couples to come together for testing and treatment because adherence to treatment levels is much higher when there is the support of a partner.”

UNICEF supports HIV prevention and treatment services in Rwanda. These services, known as the family package, provide everything from home visits to micro-credit programmes and psychosocial support.

In 2005, Laurent and Antoinette came to Nyamata Health Centre for prenatal care. They were both tested for HIV, a routine part of the centre’s prenatal services, and Laurent tested positive.

“It was a shock,” he said, “but we received good counselling from the nurses at the health centre. They taught me how to live with HIV and explained to me why I had to use condoms to protect my wife and our unborn daughter. Fortunately, she is HIV-free.”

In 2008, Laurent decided he wanted a son. He persuaded his wife to have sex without a condom, and she became pregnant once again. They went through the whole programme again, with Antoinette being tested for HIV every three months. Even though she tested negative, the couple received more counselling about why their behaviour was risky to both mother and child.

The couple’s second daughter was tested at 18 months and found to be HIV-free.

“I have promised not to pressure my wife into having sex without a condom again, but am happy, though, that we have two daughters,” said Laurent.

Scaling up efforts

“As long as we test all couples in our district and provide them appropriate treatment as necessary, we will have a better chance to eliminate the transmission of HIV,” said Theophile Ndabereye, a health care supervisor in Bugesera.

UNICEF will continue to support Rwanda’s efforts to scale up services to prevent mother-to-child transmission of the disease. The goal, said Landry Dongmo Tsague, Chief of UNICEF Rwanda’s HIV Section is to reach 100 per cent of pregnant women.

“Without early treatment, most HIV-positive children die within their first two years of life, and children born to mothers with advanced HIV are also more likely to die, even if they are HIV-negative,” he explained. “This is why scaling up elimination services will remain our focus for the years to come.”